THE EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION ADJUNCT TO LUMBAR STABILIZATION EXERCISES ON MULTIFIDUS MUSCLE THICKNESS, PAIN, DISABILITY, AND PSYCHOSOCIAL STATUS IN PATIENTS WITH CHRONIC LOW BACK PAIN

ABSTRACT Objective To assess the effects of neuromuscular electrical stimulation combined with lumbar stabilization exercises on lumbar multifidus muscle thickness, disability, pain, depression, anxiety, and fear-avoidance beliefs in patients with chronic low back pain; and to examine the correlation between ultrasound and magnetic resonance imaging of the lumbar multifidus. Design Forty patients aged 18-65 years were randomized into two groups: Group 1: exercise and Group 2: exercise + neuromuscular electrical stimulation. The participants underwent 15-session electrical stimulation and/or exercise (3 days/week). All outcome measures assessed at baseline, post-treatment, and 3 months after. Multifidus cross-sectional area on magnetic resonance imaging was measured only at baseline. Results Multifidus thickness increased, and pain decreased significantly in both groups, more prominent in Group 2. Disability, depression, and fear-avoidance beliefs scores significantly decreased in both groups, while anxiety decreased only in Group 1. Both magnetic resonance and ultrasound measurements demonstrated excellent inter-rater reliability and statistically significant correlations. Conclusion Both groups improved in terms of pain, disability, psychological status and muscle thickness. Neuromuscular electrical stimulation adjunct to lumbar stabilization exercises demonstrated enhanced effectiveness in increasing lumbar multifidus thickness.